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Tuesday, July 27, 2021

How to Break the Anxiety-Worry Habit; Handling Uncertainty, another Musing on Impermanence in the Form of Uncertainty.

Readers, how do you feel about dental work?

As I write, I sit here with a modern poultice of clove in my tooth. Yes, I said poultice, as in the old-fashioned plaster poultice that is so often applied to injuries and wounds in nineteenth-century English literature. In Jane Austen, for example. Mustard plasters and poultices were the go-to’s for first aid back then. Well, Readers, I have endured some dental work involving medicated cement in place of an old filling. This is known technically as a temporary filling, but I prefer poultice. Having dental work always strikes me as a close cousin of the barbaric practices of yore. In other words, it is something to be avoided. 

However, I was unable to avoid a particular jaw & tooth situation, which may have been (definitely WAS) created by the pandemic: jaw clenching. Clenching led, apparently, to some difficulty with a filling. You don’t need details, and really, I apologize for this much detail. Who needs it? It’s not even the point of my blog post.

As I prepared for this feat of bravery—sitting in the dentist’s chair and allowing him to perform his barbaric art upon my mouth—I thought about a recent article in Psychology Today magazine by Judson Brewer, M.D., Ph.D., professor at Brown University and clinician. His basic idea is that anxiety and worry are a habit created by a continuous feedback loop. A habit is a conditioned response, as we all know from Psych 101 or just hearing about Pavlov’s dog hearing a bell, getting a treat and salivating at the expected pleasure, over and over until just hearing the bell would stimulate the dog to salivate. 

These are not Pavlov's dogs

A habit of anxiety and worry is also a conditioned response. You feel anxious, so you worry—worry and anxiety are two different things. Brewer built his research on that of Borkovec in the 1980s, who discovered and posited that there is an element of habit in anxiety. Anxiety is a physical sensation; the sensation triggers worrying (stimulus and response), and that responding over and over to the anxiety sensation creates the habit of the anxiety-worry cycle


The apparent glitch in this theory is that worrying is rewarding. Do you find worrying rewarding? Well, Brewer says, in a certain way, worrying IS rewarding. Because anxiety is about uncertainty; we feel anxious when things are uncertain. Worrying is the response and it is reinforced because when we’re worrying we kind of feel like we’re doing something to address the uncertainty. 

Anyone who’s been in therapy—and there should be more of us, if you ask me, but then that’s the business I’m going into—has probably encountered a gentle admonition from their therapist that worrying about, say, the state of the world, makes you feel like you can control it. Or worrying, say, about your daughter driving a twelve-year-old car up and down the Eastern Seaboard, can keep her safe. We know, rationally, the worrying doesn’t do anything; but worrying becomes its own talisman. We’re afraid to let it go, because frankly, when it comes to daughters or the environment, there’s not much we can control. 

The good news is that this anxiety-worry habit can be broken. Judson Brewer, M.D., Ph.D, argues that we modern humans don’t need to feel much anxiety and worry. It’s not helpful. Contrary to popular belief it doesn’t keep us sharp and on our toes. It actually makes us feel scattered and creates difficulty concentrating and performing. So we should definitely not be proud of our intense stressed states. We should get out of the habit of having them. This is the stuff of CBT—cognitive behavioral therapy. CBT helps us identify our automatic, negative thoughts. Once we identify them, we can choose different thoughts. 

So, according to Brewer, the first step is to recognize that worrying is actually not rewarding. It is the opposite of rewarding. It is unrewarding. It makes you preoccupied. It makes you lose sight of your day and your time and your personal goals. It makes you wrinkled, grey, and old. Okay, no, that’s not true and Brewer didn’t say it. Life does that to you, if you’re lucky (a topic for a different day, perhaps). But anyway, worrying is a waste of time and energy and really doesn’t help hold up the world. This Atlas theory of world-holding by worry just exhausts us. The world will spin even if we don’t worry. Daughters will drive unreliable cars. Life seems predictable until it isn’t and then we feel uncertain. Even if we worry. And even if we don’t. 

What a concept. We don’t need to worry. It’s not helpful. In fact, it’s hurtful. This is news to me. I am happy to look at this in a new way. 

Now, anxiety is a different story. Anxiety is a natural, primitive brain response to uncertainty. (Again, paraphrasing Brewer). So the next step in breaking the anxiety-worry habit is to respond to anxiety with something that actually is rewarding. Brewer suggests that getting mindfully curious about the sensation of anxiety is one option. I am sure there are others, but that’s what I have for you for now.

Before making the dental appointment, I was full of anxiety about this tooth and this ache and what it was going to lead to. I was so anxious and worried about it that I had to really work my courage up before making the call. Once I had made the call, and Svetlana in Dr. L’s office called me back, I had much less anxiety. This was because, Readers, mindful that uncertainty triggers anxiety and worry, I did the strangely logical thing and asked Svetlana what the heck was going to happen when I got there for my appointment. Armed with as much info as I could tolerate, I headed to my appointment. Since I had spoken to Svetlana, I had much less uncertainty about what was going to happen. As I drove, I noticed that I didn’t feel terribly anxious. I noted that perhaps I felt a bit nervous, but I wasn’t worried. Because I knew what was going to happen. It wasn’t uncertain. 

Of course, a moment later, I did start to think that perhaps being neither anxious nor worried was the sign of impending doom, lamb to the slaughter type thing; the unsuspecting woman headed to disaster. My mind traveled to a scenario involving me in the dreaded chair, numbed up and hearing Dr.L say, “Oh dear, I didn’t expect this and now I must drill through your jawbone and attach a wire to keep your lower jaw on your head and by the way you have no more tooth in that spot at all, oopsie.” However, Readers, I have been around many blocks in my many years and I recognized this as a habitual anxiety loop starting up. Because I noticed it, I was able to stop it. Mostly. Remember, it takes time to form and reform a habit. I am not saying I felt completely happy about the coming procedure, but I didn’t feel anxious, just nervous. Nervous is an appropriate, alert state response. 

After that was a blur of Novocaine and trying to picture myself on a beach watching dogs frolic, and then the scent of clove wafted into my nose. Sure, my tongue now feels like a hot dog and my lips are like potato rolls. And I am sipping a chai latte through a (contraband, evil) straw trying not to let any liquid dribble out. But overall, things weren’t so bad, because I didn’t make them worse by my habit of anxiety and worry. 

Worrying is a kind of holding-on. Worrying is about desiring, usually desiring the prevention of a bad outcome. We all know desiring is the root of suffering. Desiring something over and over and over doesn’t make that thing more likely. It simply reinforces the sense of lack, the wanting in the old-fashioned definition of the word wanting. Wanting means desiring and also lacking. Letting go of thinking things should feel or be different than they are is key to just relaxing in life. Letting go of worry is a habit to establish now. 

Or so they say. It’s much easier said than done. However, practicing letting go of worry by becoming curious about how anxiety feels seems doable. 

We all want things to be certain, predictable, and permanent. Too bad, us. In fact, according to an article I read called "Decolonizing Social Work," permanence is a Western value. 

Do I believe anxiety doesn’t have to exist? That it’s evolutionary trash that should be incinerated? Uncertainty is a cousin of impermanence, and we know how we struggle with impermanence. Uncertainty can make you twitchy. You are always on edge. It creates fear of loss, according to Kahnemann and Tversky, and humans fear loss more than we enjoy winning, supposedly. So, yeah, we value permanence. And yeah, we are out of luck, because what we get is just the opposite. 

Lots of ocean and swimming metaphors surface around this topic. Plus ca change the plus they remain the same is that old French adage, isn’t it? Being certain amidst uncertainty, understanding in a visceral way that everything is always changing can be its own kind of certainty, can’t it? This is the goal of the enlightened, I suppose. We befriend our anxiety in a non-clinging sort of way and maybe it’ll fade away. But we never lose our edge, we’re always having to make some minor adjustments to stay afloat. That’s the metaphor. That’s the truth. However, we don’t have to worry about it. 

We can all feel as peaceful as this scene. With practice. Lots of practice. 

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